Central pontine myelinolysis occurs inconsistently as a complication of severe and prolonged hyponatremia, particularly when corrected too rapidly. This condition is a concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis. We describe a head injury patient who developed central pontine and extrapontine myelinolysis following a gradual correction of hyponatremia. More attention should be paid to correcting hyponatremia combined with hypokalemia in patients who have a history of alcoholism.
Alcoholism ; Brain Injuries* ; Craniocerebral Trauma ; Demyelinating Diseases ; Humans ; Hypokalemia ; Hyponatremia* ; Myelinolysis, Central Pontine*

OBJECTIVE: The intracranial pathologies after head trauma should be usually progressed. It is clearly visualized in the non-invasive brain CT. The invasive monitor such as intracranial pressure (ICP) monitoring may be accompanied with the complications. This study aims whether the patients with severe head injury could be managed with serial CT scans. METHODS: The medical records of 113 patients with severe head injury in the prospectively enrolled trauma bank were retrospectively analyzed. After the emergency care, all the patients were admitted to the intensive care unit for the aggressive medical managements. Repeat brain CT scans were routinely taken at 6 hours and 48 hours after the trauma. ICP monitoring was restrictively applied for the uncertain intracranial pressure based on the CT. The surgical intervention and the mortality rate were analyzed. RESULTS: Immediate surgical intervention after the initial CT scan was done in 47 patients. Among the initially non-surgical patients, 59 patients were managed with the serial CT scans and 7 with the ICP monitoring. Surgical interventions underwent eventually for 10 patients in the initially non-surgical patients; 1 in the ICP monitoring and 9 in the serial CT. The mortality rate was 23.7% in the serial brain CT and 28.6% in the ICP monitoring. There was no statistical difference between two groups in the aspect of mortality (p=0.33). CONCLUSION: Serial CT scans in time could be a good way to monitor the intracranial progression in the severe head injury and reduce the implantation of an invasive ICP probe.
Brain* ; Craniocerebral Trauma* ; Emergency Medical Services ; Humans ; Intensive Care Units ; Intracranial Pressure* ; Medical Records ; Mortality ; Pathology ; Prospective Studies ; Retrospective Studies ; Tomography, X-Ray Computed*

OBJECTIVE: Septa within the hematoma cavity are common, especially in the mixed density chronic subdural hematomas (CSHs). Although CT remains the diagnosis of choice, MRI is superior to detect the membranes in CSHs. We could obtain MRIs in 64 patients with CSH. We examined the value of MRI to understand the history of CSH. METHODS: We retrospectively examined the medical records and MRIs of 64 consecutive patients. MRI was selected to find any organic causes of neurologic symptoms. We classified the CSHs into septated or non-septated group, since classification of the septa was frequently obscure. RESULTS: Septa were identified by MRI in 43 patients (67%). They were more common in the over 70-years-old group. Unknown causes were more common in the septated group, which implies they might suffer from multiple traumas. The signal intensity of the CSH was variable. The methods of treatment were different between two groups. Surgery was more common in the septated group (p=0.021). Surgery was performed in 57 patients (89%). Burr-hole drainage was successful in 55 patients, even in the septated group. CONCLUSION: Septa within the hematoma cavity may be related to the multiple episodes of head trauma. Repeated trauma may cause acute bleedings over the CSHs, which is one of the pathogenic mechanisms of hematoma enlargement. MRI could show the history of CSH.
Classification ; Craniocerebral Trauma ; Diagnosis ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Membranes ; Multiple Trauma ; Neurologic Manifestations ; Retrospective Studies

OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common types of intra-cranial hemorrhages usually associated with trauma. Surgical treatment is the treatment of choice and burr hole trephination (BHT) is widely performed. The recurrence rate in the patients with CSDH is 3.7-30%. This study investigated the risk factors associated with the recurrence of patients with CSDH who underwent BHT. METHODS: One hundred twenty-five patients with CSDH underwent BHT. Eight of 125 patients (6.4%) underwent reoperation for recurrent CSDH. We retrospectively analyzed demographic, clinical and radiological findings, catheter tip location and drainage duration as the risk factors for the recurrence of CSDH. RESULTS: Recurrence of CSDH in the high- or mixed-density groups was significantly higher than those in the low- or iso-density groups (p<0.001). Placement of catheter tip at the temporoparietal area was associated with a significantly higher recurrence rate of CSDH than placement at the frontal area (p=0.006) and the brain re-expansion rate (BRR) was much lower than placement at the frontal area (p<0.001). CONCLUSION: The operation may be delayed in high- and mixed-density groups, unless severe symptoms or signs are present. In addition, placing the catheter tip at the frontal area helps to reduce the incidence of postoperative recurrence of CSDH and to increase the BRR.
Brain ; Butylated Hydroxytoluene ; Catheters ; Drainage ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Incidence ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors* ; Trephining*

OBJECTIVE: Re-implantation of autologous skull bone has been known to be difficult because of its propensity for resorption. Moreover, the structural characteristics of the area of the defect cannot tolerate physiologic loading, which is an important factor for graft healing. This paper describes our experiences and results with cranioplasty following decompressive craniectomy using autologous bone flaps. METHODS: In an institutional review, the authors identified 18 patients (11 male and 7 female) in whom autologous cranioplasty was performed after decompressive craniectomy from January 2008 to December 2011. We examined the age, reasons for craniectomy, size of the skull defect, presence of bony resorption, and postoperative complications. RESULTS: Postoperative bone resorption occurred in eight cases (44.4%). Among them, two experienced symptomatic breakdown of the autologous bone graft that required a second operation to reconstruct the skull contour using porous polyethylene implant (Medpor(R)). The incidence of bone resorption was more common in the pediatric group and in those with large cranial defects (>120 cm2). No significant correlation was found with sex, reasons for craniectomy, and cryopreservation period. CONCLUSION: The use of autologous bone flap for reconstruction of a skull defect after decompressive craniectomy is a quick and cost-effective method. But, the resorption rate was greater in children and in patients with large skull defects. As a result, we suggest compressive force of the tightened scalp, young age, large skull defect, the gap between bone flap and bone edge and heat sterilization of autologous bone as risk factors for bone resorption.
Autografts ; Bone Resorption ; Child ; Cryopreservation ; Decompressive Craniectomy ; Hot Temperature ; Humans ; Incidence ; Male ; Polyethylene ; Postoperative Complications ; Risk Factors ; Scalp ; Skull ; Sterilization ; Transplants*

OBJECTIVE: This retrospective study was undertaken to evaluate the efficacy of combined microscopic fragmentectomy and intraoperative nucleoplasty for sequestrated lumbar disc herniation. METHODS: Twenty-four patients with magnetic resonance imaging proven sequestrated lumbar disc herniation with small annular leak treated by microscopic fragmentectomy and nucleoplasty were included. Patients were followed for at least one year. The Oswestry Disability Index (ODI; version 2.0) was used to assess preoperative and postoperative functional statuses in three age groups (20-40, 41-60, and >60 years). Visual analog scale and modified MacNab's criteria were used to assess the clinical outcomes for spinal surgery. RESULTS: Mean age at operation was 41.2 years (range 20-72 years). ODIs improved significantly regardless of age group. Significant pain relief was achieved at 1 year after surgery. Most patients (92%) had an excellent or good result according to modified MacNab's criteria, and all patients showed symptomatic improvement after surgery. There were two postoperative wound-related complications, and both responded to antibiotics. No patient underwent further additional surgery because of disc re-herniation during follow-up. CONCLUSION: This study shows that combined microscopic fragmentectomy and intraoperative nucleoplasty without additional discectomy provides a safe operative option for the treatment of sequestrated lumbar disc herniation with small annular leak.
Anti-Bacterial Agents ; Diskectomy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Visual Analog Scale

OBJECTIVE: This study describes a method for inducing spinal cord injuries in dogs by using balloon catheters via laminectomy and the subsequent changes in the electrophysiological response. METHODS: Female Beagle (Orient Bio, Seongnam, Korea) dogs weighing 10 kg at the time of injury were used. Under inhalation anesthesia, a posterior midline approach laminectomy was performed. A silicone balloon catheter (size 6 Fr; Sewoon Medical, Cheonan, Korea) was then inserted into the vertebral canal at the center of T10. The balloon was inflated to the maximum volume for 1, 2, or 3 days. Open field testing was performed for evaluating motor functions of the hindlimbs. Motor evoked potentials (MEPs) induced by electrical and magnetic stimulation were recorded before and after spinal cord injury. RESULTS: Open field testing yielded locomotor scores of 0 or 1 for dogs subjected to compression for 3 days. These dogs showed no obvious improvement throughout the observation period, and the tonus of their hindlimbs was flaccid. In contrast, motor functions of dogs that had experienced compression for 1 or 2 days were variable, and all dogs showed spastic tonus in their hindlimbs. In dogs subjected to after compression for 3 days, electrically stimulated MEPs for the hindlimbs showed a significant amplitude reduction. Further, hindlimb movements were not evoked by magnetic stimulation of the cervical spine and vertex area. CONCLUSION: Compression for 3 days with a balloon catheter is a safe, reproducible, and reliable method for evaluating electrophysiological changes in a dog model of complete spinal cord injury.
Anesthesia, Inhalation ; Animals ; Catheters ; Chungcheongnam-do ; Dogs* ; Evoked Potentials, Motor ; Female ; Gyeonggi-do ; Hindlimb ; Humans ; Laminectomy ; Muscle Spasticity ; Silicones ; Spinal Cord Injuries* ; Spine

Pituitary apoplexy usually presented with abrupt onset of neurological deterioration of headache, visual disturbance and decreased mental status. Post-traumatic pituitary apoplexy generally occurs in patients who have suffered from severe head injury, but there are rare reports occurred in patients with mild head injury. We describe a rare case of atypical presentation of acute pituitary apoplexy following mild head injury. A 68-year-old woman presented with right parietal scalp swelling after minor head trauma. Glasgow Coma Scale (GCS) score was 14. Initial computed tomography (CT) scans showed multiple contusions in the basal forebrain, falx hemorrhage and a linear skull fracture near the midline. In addition, there was a suprasellar-extended pituitary macroadenoma with suspicious intratumoral hemorrhage. After admission, cloudy consciousness, poor oral intake and high fever continued for several days. On seventh day, her condition has abruptly deteriorated and hypotensive shock developed. She recovered dramatically two days after steroid replacement therapy. The mechanism of pituitary apoplexy after mild head injury discussed with a relevant literature.
Consciousness ; Contusions ; Craniocerebral Trauma ; Female ; Fever ; Glasgow Coma Scale ; Head ; Headache ; Hemorrhage ; Humans ; Pituitary Apoplexy ; Pituitary Neoplasms ; Prosencephalon ; Scalp ; Shock ; Skull Fractures

Currently, endovascular treatment of carotid cavernous fistula (CCF) is widely accepted and performed. However, a graft stent is rarely used for the treatment of high-flow CCF. Here we describe our experience using a graft stent to treat CCF and discuss the indications for its use.
Caves ; Fistula ; Stents ; Transplants

We report an unusual case of skull perforation and depressed fracture with epidural hematoma in a 61-year-old woman who has been undertaken a skeletal fixation for stereotactic evacuation of intracerebral hematoma. Most neurosurgeons secure the patient's head in a skeletal fixation device with a three- or four-pronged pin-type headrest for stereotactic procedure or microsurgery. Although a variety of complications have been reported secondary to the use of head fixation devices, these potential complications of skull fixation have been infrequently described in the medical literatures. Consideration of calvarial thickness, tightening force, and adequate location of skull fixation may reduce the risk of skull perforation and depressed fracture.
Female ; Fracture Fixation ; Head ; Hematoma ; Humans ; Microsurgery ; Skull